Let's ramble!

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After the coming of hospital’s contracted diseases such as C. difficile or MRSA (Methicilin-Resistant Staphylococcus Aureus), another difficult to treat bug seems to emerge. This time, it is a fungus: Candida auris.

This fungus or more precisely this yeast, has first been discovered by scientists in 1996. Then, a first infected human case has been reported in Japan in 2009. 1,2 To this date, Candida auris has been detected in hospitals of more than 20 countries such as the United States of America, England and many Europe countries. The first case in Canada has been reported in 20173.

Candida auris poses a specific threat because of the following characteristics4:

Infections by this microorganism have a high mortality rate.

The microorganism resists antifungal agents.

The microorganism is difficult to identify in clinical microbiology laboratories which results in wrong diagnostic. The identification is important in the choice of antifungal treatment.

The microorganism is known for its virulence.

The microorganism colonizes surfaces such as catheters used for healthcare.

Among recommended precautions by American and Canadian governments, disinfection of surfaces plays an important part. However, specific disinfectants are to avoid: this is notably the case for quaternary ammonium-based disinfectants which are ineffective5. The following procedure is rather recommended:

« Healthcare facilities that have patients with C. auris infection or colonization should ensure thorough daily and terminal cleaning and disinfection of these patient’s rooms with hospital-grade disinfectant effective against Clostridium difficile spores. »6

Sporicidal sodium hypochlorite-based disinfectant against C. difficile are for example great disinfectants to prevent and control contact transmission of Candida auris. In other words, scientists are only starting to understand and study this recently discovered microorganism. More studies will allow the discovery of effective treatment.

Until that time,in need of sporicidal products against C. Difficile to face Candidaauris new threat? Get our products right now!

Antibiotics have been around for almost 100 years now, and have proven to be very effective against fighting harmful bacterias. However, during this time, these bacteria had time to evolve and many of them are now becoming “drug-resistant”, meaning that these bacteria have developed a resistance to antibiotics. There are even some bacteria, known as “superbugs”, that have become resistant to nearly every existing antibiotic. If a person is infected with a “superbug”, this means they cannot seek treatment from antibiotics and will have to rely solely on their immune system to fight the disease. This could result in death by diseases that were once treatable. According to the United Nations World Health Organization, “By 2050, estimates indicate that more people could die from antibiotic resistant infections than those who currently die from cancer” (2016), making drug-resistant bacteria one of the most serious health concerns that we face.

Source: Wikimedia Commons

So if antibiotics are becoming ineffective, then what can be done? Researchers are now turning towards a “good virus” called a “bacteriophage”, or simply phage, that kills bacteria, which was previously overlooked by researchers and scientists.

Phages: The Virus that kills drug-resistant superbugs

First of all, what is a phage? Simply put, phages are viruses that infect specific bacteria (Motherboard, Vice). This means that bacteriophages do not infect human or animal cells. There are more phages on earth than any other living specimen, and they can be found almost anywhere. There are also many different kinds of phages, and each phage does not fight the same bacteria.

Phages kill bacteria by binding themselves to the membrane of the bacteria when they come in contact with it and then releasing an enzyme that drills a hole in the bacteria cell. The phage then injects its own DNA into the cell and reproduces more phages inside of it. This causes the bacteria cell to explode (Motherboard, Vice). Phages can therefore be used as a natural alternative to antibiotics, and may prove to be even more effective.

Source: Wikimedia Commons

In the early 1900s, phages were studied by many researchers and scientists all over the world, however, after the invention of antibiotics, Western countries became less interested in phages and any research about the viruses were put to a halt. The Soviet Union, on the other hand, kept investing in phage research and Russia, Georgia and Poland are among the only countries that use phage therapy today as a bacteria-fighting technique. Research scientist Benjamin Chan (Yale University) explains that the United States has been “hesitant to use bacteriophages because they’re a virus.” However, he goes on to explain that there are many types of viruses and virus does not always mean that there is a disease involved.

Will phages replace antibiotics in the future?

Maybe. It will take some time, as much research still needs to be done by Western countries. Many science researchers believe that they will begin to be used out of desperation. One thing is for sure though: our current antibiotics will no longer be a sustainable option and we need to find another alternative and fast!

Hospitals have always had ups and downs, according to the New York Times (2018). During the 19th century, wealthier people preferred being treated by doctors in their homes and hospitals were seen as a place for poorer people. Hospitals were not known for having good conditions. However, research led hospitals to learn some of the best practices and new technologies, such as anesthesia, which allowed hospitals to give better treatment than at home.

These new pratices and technologies caused more people to start going to hospitals. But now, people are once again shifting towards medical assistance at home or choosing to go to small clinics rather than going to hospitals. Why are these changes happening and what has been the implications for healthcare facilities?

Source: Wikimedia Commons

Why are hospitals shutting down?

According to the New York Times (2018), the maximum number of hospitalizations in the US was over 39 million, in 1981. Even though the population has increased, hospitalizations have decreased by 10 percent! (New York Times, 2018). There are many different reasons explaining these numbers.

Aside from less patient admissions, the number of days a patient spends in a hospital is much shorter than before. Previously, a patient who had surgery could spend a week or longer in the hospital. However, now patients who have surgery sometimes stay only one day! This is one of the reasons for the reduction of hospital beds. According to Modern Healthcare (2015), new technologies and better medications can either reduce the length of the stay of a patient, or receive the necessary treatment outside of a hospital.

Second, one of the biggest problems that hospitals face today are hospital-acquired infections and trying to control the spread of infection. Hospital-acquired infections are becoming an increasingly serious problem, especially with the rise of drug-resistant suberbugs.

According to the Center for Disease Control and Prevention, in 2002, there were 1.7 million cases of HAIs, and that number has only been increasing. Controlling the spread of bacteria in hospitals has become increasingly challenging and, as you have seen on this blog, researchers are constantly finding new sources of infection. As people are becoming more aware of this risk, they are opting for either smaller healthcare facilities with less risk or at-home care.

One of the biggest causes for hospital closures is lack of funding; some hospitals simply cannot sustain themselves. In the US especially, this is in part due to patients being unable to pay hospital fees or having complications with insurance companies and, therefore, postponing their treatments. Hospitals are now scrambling to cut costs, however, this does not always work and has led to many closures.

The costs of shutting down hospitals

The majority of hospitals being shut down are in rural and small town areas, where people are far from cities. These closures can lead to many problems for these people. Doctors may lose their jobs or have to relocate to other cities to practice. Similarly, patients no longer have the option of having a regular, family doctor and need to relocate themselves in order to seek medical attention. They will also incur higher costs to reach the hospital, since they have to travel to hospitals. They lose time travelling, which may even be deadly in some cases. Finally, in the video example below, we see that the loss of jobs from a hospital closure can be detrimental to a small town’s economy, leading to the closure of other companies.

What does the future for hospitals look like?

So what is going to happen to hospitals? Will they eventually all disappear? Although a total disappearance is highly unlikely, it seems that hospital closures are becoming unavoidable, due to the risks associated with hospital-acquired infections, changing consumer preferences and lack of funds to maintain hospitals. There has already been a signifcant number that have been closed since 1981; in 1981, the US had 6933 hospitals and by 2017 this number had dropped to 5534 (New York Times, 2018). And this trend is expected to continue in Western countries. We’ll just have to wait and see what the outcome will be…

Preventing and controlling the spread of contamination and infection is of very high importance for healthcare facilities, and it is safe to say that many measures have already been taken in order to reach these goals. However, like many things, there is still much room for improvement moreover when it is about surface damage.

Source: Shaw Air Force Base

Evidently healthcare facilities use a wide variety of equipment, from monitors to surgical instruments to cleaning tools, and over time, this equipment wears down. Sometimes, equipment will break completely and be unusable, however sometimes there will only be a few scratches or other small damage. But what happens when these scratches or other forms of damage become shelters and areas of growth for microorganisms? This is an example of how surface damage may not only impede the prevention of bacteria growth, but also provide the microorganisms with a place to grow.

What is surface damage?

According to Infection Control Today, surface damage is defined as:

a quantifiable physical or chemical change from the original manufactured state of an object (surface or device).

While it is recognized that surface damage of medical equipment poses a potential threat in the spread of bacteria in healthcare facilities, there is no standardized method for healthcare workers to determine what is considered surface damage, and at what point the damage is likely to cause the spread of bacteria. In a later blog post, I will discuss the ideal surface damage testing protocol, proposed by Peter Teska et al. in “Infection Control Today.” In this article, the authors discuss ideal methods of avoiding the problems that surface damage presents.

Are your surfaces damaged?

At Lalema, when we talk about hygiene and cleanliness, we offer a wide range of technical and consulting services. Find out more.

As a follow-up to my previous blog post about the problem of hospital bed mattresses being contaminated, I would like to go into further detail the recommendations provided by the Food and Drug Administration (FDA). As previously mentioned, the FDA recommends that healthcare facilities take preventative measures against contamination of hospital bed mattresses in four simple steps: inspection, removal and replacement, maintenance and the development of an inspection plan.

Source: Flickr

Inspection involves routinely checking the bed mattress cover for any signs of damage, stains or tears, as well as checking if the bed mattress cover is past its expiry date (Yes – bed covers do have a limited lifespan). It is also important to frequently remove the cover and check the inside surface, as well the mattress itself for these same conditions.

Next, it is important to replace any mattress covers with visible signs of damage or stains. Also, mattresses with damage or visible stains should be removed immediately.

For maintenance, it is important to clean and disinfect undamaged bed mattress covers. This can be done according to the bed cover cleaning guidelines given by the manufacturer.

Finally, FDA suggests that healthcare facilities develop an inspection plan that can be applied for all medical bed mattresses and covers. It is important to check the expected life of the bed mattress, as well as the cover.

Hospital beds are composed of many different parts: the bed frame, which includes the bed side rails, as well as a mattress and a mattress cover. Once a patient is discharged from the hospital, normally, the room will go through a substantial amount of cleaning, including the bed. The rails and bed frame will be wiped down and the bed cover will be changed in order to prepare for the next patient. However, one factor is often dismissed: the hospital bed mattress.

📷 pixabay.com

According to the ECRI Institute:

Bed and stretcher mattresses can remain contaminated after cleaning, putting patients and staff at risk of exposure to body fluids or microbiological contaminants. Reported incidents include patients lying on an apparently clean bed or stretcher when blood from a previous patient oozed out of the support surface onto the patient.

While hospital bed covers are changed regularly, many health care facilities fail to examine these bed covers for damages, heavy stains or tears. It is also important to note that mattress covers have an expected lifespan, and will become ineffective after this duration of time. All of these factors can lead to blood or any other body fluids leaking onto the hospital bed mattress, therefore leaving it contaminated.

The FDA (Food and Drug Administration) makes several recommendations in order to overcome this healthcare hazard:

Inspect

Remove and Replace

Maintain

Develop an Inspection Plan

While companies who sell the mattress covers have the responsibility in properly explaining to healthcare facilities how to properly disinfect, clean and dispose of bed covers, it is crucial for healthcare facilities to use the necessary materials and procedures in order to clean and disinfect. Healthcare facilities must also regularly inspect both mattress covers and mattresses in order to prevent infection as much as possible.

Influenza is a stubborn virus. Moreover, every year, the virus is changing and it’s another race against time to produce a new vaccine, often composed of several strains, which will be able to protect the most vulnerable population such as young children, the elderly and sick people.

AN ENCOURAGING RESEARCH on INFLUENZA

According to the article by Radio-Canada:

At Laval University, Gary Kobinger’s team is testing a new influenza vaccine, which could provide better protection and long-term immunization. The formula incorporates much of the circulating influenza strains over the last 20 years.

A first clinical trial to test the safety of the vaccine ended a few months ago. According to the researchers, it shows that the product does not cause significant side effects.

The effectiveness of vaccines against influenza (the flu) is also limited especially when we guess wrong the strain that will be the most virulent that year!

THE IMPORTANCE OF HAND WASH

We are all at one point exposed to the flu virus. A good way of individual prevention is to put on your hat on and tie your coat. I am joking. On the other hand, regular hand washing before meals, after the toilet and even just when arriving at work or at home is really an effective way against the spread of the virus.

Regular hand soaps like Utopia or antibacterial soap like Utopia AB do the trick.

Did you know that our soaps do not contain any: methyisothiazolinone?

THE IMPORTANCE OF SURFACE DISINFECTION

Cleaning worker also plays a very important role in the winter period when it comes to disinfecting surfaces. Specialty products such as the Ali-Flex line of product offers many benefits:

SURFACES DISINFECTIONS

According to Health Canada2, in the event of a spill or contaminated surfaces:

Let the aerosols fall; wear protective clothing, carefully cover the spilled material with paper towels and apply 1% sodium hypochlorite from the periphery to the center; allow to act for a sufficient period (30 minutes) before cleaning

As you know, improper and inappropriate use of antibiotics has resulted in bacteria developing resistance mechanisms. In general, we observe a decrease in the effectiveness of antibiotics in fighting multiresistant bacteria. In fact, the antibiotics that were developed between 1940 and 1980 generally had a very specific target, which facilitated the acquisition of resistance mechanisms by bacteria. In addition, the new antibiotics that are marketed are generally similar to existing antibiotics, making resistance acquisition even easier for bacteria. Thus, all the preceding facts suggest the importance of developing new antibiotics displaying novel mechanisms of action.

One of the alternatives is to develop antibiotics targeting the cell membrane of bacteria. Among others, we find the natural antimicrobial peptides that are a class of molecules participating in the immune response of several organisms such as bacteria, plants and mammals [1]. These peptides have the ability to form pores or to induce defects in the cell membrane, which will lead to a disturbance of the electrochemical gradient across the membrane, thus causing cell death (FIG. 1) .

Figure 1: Illustration of the main mechanisms of cationic antimicrobial peptides [3].

Inspired by these natural peptides, many researchers are attempting to develop synthetic antimicrobial peptides that will be both less toxic and pharmacologically viable. On the market, we find daptomycin (Cubicin®) which acts by a mechanism similar to natural antimicrobial peptides [4]. This antibiotic from the lipopeptide family is used for the treatment of infections involving methicillin-resistant Staphylococcus aureus (MRSA). It is interesting to note that, like natural antimicrobial peptides, quaternary ammoniums, which are commonly used in disinfection operations, also destroy bacteria because of their membrane activity [5]. At Lalema, a wide range of quaternary ammonium-based disinfectants are available to meet your needs.

The ever-growing problem of antibiotic resistance is a major health issue and a heavy tax burden on governments. The use of an adequate antibiotic management system, the advent of new technology and better control of the transmission of pathogens (disinfection) are essential tools to reverse the current trend.

For a long time, cleaning has been all about the look; fresh smell and the absence of stains or dirt were the criteria to determine that a place is clean. Today, these criteria are still generally accepted in environments such as offices and classrooms.

It’s common knowledge, however, that microbes (bacteria or viruses) invisible to the human eye represent a risk for spreading infections. Take the example of the influenza virus: it can survive for up to 48 hours on a hard surface!

Without cleaning and disinfection procedures or a quality check procedure, microbes can survive in hospital environments.

Three key elements have to be considered in order to perform an infective risk analysis:

Is the patient carrying a disease agent? Disease agents are classified based on their spreading capacity and their virulence. The choice of a disinfectant will be based on this.

Do the functional activities of a sector represent a risk of spreading infections from the environment? E.g.: food service, offices, Intensive Care, etc.

The intensity of contact is related to the traffic and the surfaces that are more likely to be touched. E.g.: bathroom fittings.

Infective Risk Analysis

Cleaning in hospitals allows reducing risks of infection among patients. This is not the only factor, of course: good personal hygiene habits such as washing hands and the use of protective equipment such as overalls, gloves, masks, or protective glasses are also important elements.

For this reason, interventions must be well coordinated in order to have a good surface maintenance plan. The manager of hygiene and cleanliness should therefore take into account:

The type of place associated to the level of risk

The tasks to perform

The required cleaning frequency

If well applied, a detailed estimate allows validating the cleaning performance.

Balance of microorganisms. This approach is based on the competition between good and bad microbes. The presence of good microbes guarantees less space for bad microbes to grow (e.g.: living environments)

The Cleaning Staff: key to success

The hygiene and cleanliness staff represents a key element in the fight against infections in hospital environments. Often little valued, their role in the global strategy of surface cleaning is extremely important.

The hygiene that comes from the work of the cleaning staff requires a high performance level. In order to reach that, the executing staff and the managers need to master all the different elements representing this profession.

Cleaning products and equipment are undeniably crucial in order to ensure performance during the environment asepsis of any establishment. Therefore, it is important to associate the day-to-day actions of the cleaning staff with a range of products and equipment that favor the quality of their performance.

Since several years, partly due to the devotion and the involvement of many members in the healthcare system, we take into consideration new factors:

Provincial training

Establishment of an AEP hygiene and cleanliness in healthcare environments of 630 hours now offered by many school boards

Provincial day of hygiene and cleanliness

Etc.

Having said this, the hygiene and cleanliness staff deserves our deepest gratitude. Thank you so much!

Work Organization

How can proper work organization contribute to the cleanliness of a hospital? How to be in the right place with the right equipment? Here are the questions we are going to answer in this post of the Cleaning in Hospitals series.

Evaluation of production needs

First, we need to assess the needs in hygiene and cleanliness. In order to do this, a standard evaluation is preferable but it needs to be adjusted based on the type of place, units, and traffic.

It is during the evaluation of needs that the hygiene and cleanliness estimate (see Cleaning in Hospitals part 2) is going to be determined. All daily, weekly, monthly, and annual tasks have to be considered.

Usually, the results are presented by production yields (square meters/hour) or FTE (Full Time Equivalent).

How to reduce time waste

How to measure productivity in a context where an important aspect of the task is moving? Actually, hygiene and cleanliness departments are almost always in the basement, whereas most of their work happens on the floors!

We increase productivity by reducing traveling.

It is for this reason that the cleaning cart needs to be as complete as possible and the water sources or janitor’s closets well stocked with supplies (i.e.: paper products or waste bags), equipment, and sanitary products.

Moreover, it is important to remember that a good entrance carpet can greatly reduce dirt.

Have a successful day!

Here are a few hints on how to have a successful day:

Establish a sequence of actions to perform in a day/week/month

Define a sequential order of rooms

Integrate linked and periodical tasks (monthly)

Make sure to have time gaps to focus on periodical tasks (dusting of high surfaces, polishing, etc.)

Minimize traveling

Work by space and not by task

Distribute tasks equitably

One look is worth a thousand words: choose a colorful plan together with some graphics instead of a list of tasks on a word file!

Want to know more?

Look this free webinar from my collegue Remi:

Need help?

Don’t hesitate to call 514.645.2753 or subscribe to one of our training seminars. I really hope that you liked this post!

One can not stop the progress. The discovery of an enzyme capable of preventing the production of a biofilm, this polymeric protective layer produced by bacteria that prevents antibiotics and surface disinfectants from functioning well, could ultimately revolutionize the fight against nosocomial infections.

We demonstrate that glycoside hydrolases derived from the opportunistic fungus Aspergillus fumigatus and Gram-negative bacterium Pseudomonas aeruginosa can be exploited to disrupt preformed fungal biofilms and reduce virulence.

What is a biofilm?

My colleague Rémi Charlebois described biofilms as follows:

Biofilms found on surfaces are often derived from a complex colony of microorganisms producing polymers that allow them to adhere better to the surface and facilitate colony life. In short, a biofilm is like a city for microbes. Man has learned to tame these biofilms and can use them to treat wastewater or produce certain molecules such as natural plastics. However, the presence of unwanted biofilms could be harmful and can lead to infections.

Biofilms are also found on the skin and medical devices. Thus, according to the article of Le Devoir:

Biofilms, a highly sticky matrix of proteins and sugar polymers made by bacteria to protect themselves, are attached to the skin, mucous membranes or the surface of biomedical materials, including catheters, tubing, heart valves and other prostheses Which become preferred entry points for infection.

In the same article, Dr. Sheppard quotes:

Biofilms are produced by molecules that defend against our immune system or against antibiotics with this shell that is 1000 times more resistant than the organisms that produce and proliferate in these biofilms.

An enzyme that acts as a “destructive machine” for biofilms

In short, the enzyme discovered was modified to destroy the biofilms instead of forming them. This is a new strategy that can reduce nosocomial infections in healthcare centers.

Recently, my friend Rémi wrote on Twitter: “Why is it so long to get rid of Polio in the world? “, Did you know that there are barely 30 cases per year in the world! Only 3 countries in the world still have Polio cases. One of these 3 countries, Nigeria is on track to succeed with no cases reported since 1 year.

Credit CNN

Should we worry about the anti-vaccine movement?

In the report on CNN twitted by Rémi, the specialist mentions that the number of children not vaccinated in the United States is growing continuously. Will we have to wait for another epidemic?

Surface disinfection against poliovirus type 1

According to Health Canada, in its guideline – Safety and Efficacy Requirements for Disinfectants Assimilated to Hard Surface Drugs, a broad spectrum virus is defined as:

Broad-Spectrum Virucide: A disinfectant that is shown to be effective against a representative, envelope-free and hard-to-kill virus, which is also intended to inactivate other enveloped and envelope-free viruses (ie a product of which A “broad spectrum virucide” efficacy has been demonstrated).

Also according to Health Canada:

The incidence of poliomyelitis in Canada declined following the creation of vaccination programs in the 1950s. The last indigenous case of wild poliovirus infection in Canada dates back to 1977. In 1994, the World Health Organization Officially declared Canada free from wild poliovirus. The cases of paralytic poliomyelitis that have occurred in Canada since then have been associated with imported cases of wild poliovirus infection and the use of OPV.

According to the MSSS, in its guide “Disinfectants and disinfection in hygiene and sanitation: fundamental principles”

Among the viruses are those that are enveloped by a lipid layer and those that are not. These are called naked viruses. Paradoxically, this lipid-rich envelope is easily altered by chemicals, making wrapped viruses vulnerable. In contrast, naked viruses are “accustomed” to coping with outdoor conditions and are more resistant to disinfectants. Generally, if a disinfectant is active against naked viruses, such as polio, it is likely to be active against enveloped viruses, such as AIDS (HIV).

Quaternary or sodium hypochlorite disinfectants

Quaternary or sodium hypochlorite disinfectants with the “broad-spectrum virucidal” claim are effective against naked viruses such as polio.

Several tasks accomplished by ants are similar to those of human professions such as farmer or breeder. Swiss researchers recently added a surprising task to this list: chemist!

Credit David Higgins, Unsplash

Community life

We all know that anthills are full of ants. A population of a colony can easily reach several millions. Although they may be insects, food supply, waste management and infection control are, believe it or not, a major concern for the queen of an anthill.

The chemist ant

By mixing coniferous resin with formic acid (a venom secreted by ants to combat their enemies), the mixture doubles the antifungal efficacy of the resin alone. These ants are capable of improving the resistance of the colony to pathogens. This is the first time that we have observed, apart from humans, a species mixing different compounds in order to improve their effects.

Hard surface Disinfection in the human world

At Lalema, conifer resin and formic acid are not used to make our disinfectants. On the other hand, our formulas are developed and validated by real chemists in addition to being registered with the appropriate governmental bodies.

Our exclusive Certiklör technology allows our sodium hypochlorite products such as Ali-Flex RTU to have the following advantages over the competitor’s products :

According to ASSTSAS, falls and slips account for 18% of workers’ compensation costs in the province of Quebec. This is the third leading cause of workplace accidents in the health and social services sector and it includes all types of jobs.

Causes of workplace accidents

There are many other causes of workplace related accidents :

Fall and slide accidents

Muscle problems related to lift and flexion

Eye and skin lesions, often related to the handling of chemicals

Respiratory problems, often the result of working with chemicals and equipment

When selecting or standardizing cleaning products, the involvement and participation of your staff is essential. It is important to set up a participatory structure (mandatory user committee) for the acquisition of products and equipment. This would not only lead to a greater accountability from the users, but it will also bring a higher degree of satisfaction.

This structure would allow managers :

To listen to users and to promote their full autonomy;

To establish internal standards for any product. Such standards should truly reflect the needs of users;

To review product stock to ensure they remain relevant;

To specify, with users, technical specifications of products for purchasing according to the standards of the institution;

To educate stakeholders on the content of standards and their use;

To enhance internal resources in terms of products and equipment.

Participatory approach for the staff with the managers

Managers and users must be trained to properly select products and their many uses to avoid handling errors, improper dilution and to grab the security concepts associated. This is an essential prerequisite which is part of a participatory process that will generate a consensus from the janitors about the choice of cleaning products and initiate actions and training of new practices.

When it comes to cleanliness, some people are mixing technical terms leading to ambiguity. It is like mixing chemicals together: That is not a good idea! To keep it simple, we’ll just give three useful definitions.

Deteriorated surfaces

A deteriorated surface shows wear off sign often caused by time or misuse.

Deterioration is one of three elements of impairment of property, the others being functional obsolescence (or obsolescence) and economic obsolescence.

Safe surfaces

Safe surface means that it is safe to health. Such surface is healthy or good for health often because of risk management. In the food industry, this is why we often refer to it as food safety.
Safe is also synonymous to hygienic !

Disinfected surfaces

Disinfection is a voluntary momentary removal operation of certain bacteria (if it comes to “all germs” we refer more to sterilization), so as to stop or prevent infection or the risk of infection or superinfection by pathogenic or undesirable microorganisms or viruses.

For example:

To sanitize a surface eliminates 99.9% of microorganisms (This is a 1,000 X reduction)

To disinfect a surface removes 99.999% of microorganisms (This is a 100,000 X reduction)

To sterilize a surface or instrument removes 99.9999% of microorganisms (This is a 1,000,000 X reduction)

Obviously, “momentarily” is a key fator because the surface will be contaminated again as soon a a contaminant will enter in contact with the it. That’s why some disinfectants have a residual effect that prolongs the action of disinfectant for a certain time.

The days when visual room inspection used to be the gold standard for monitoring hospital cleanliness is long gone. Even though this practice is still useful, better and more objective ways have seen the light. One of the most scientific way is surface cultivation. However, surface cultivation is labor intensive and lacks on the spot results. Invisible UV markers and UV light are also a good way to validate if a place was cleaned. However, its application is limited and the data are not telling more then if a surface was cleaned or not at a given time. ATP testing is becoming more and more useful to verify cleanliness beyond visual inspection.

How does ATP monitoring works?

ATP monitoring is a simple and quick way for hospital to measure residual organic matter on a surface, device or piece of equipment. Adenosine triphosphate or ATP is an organic molecule found in every living or once-living organism. Essentially, the person conducting ATP monitoring swabs the surface of concern, and insert that swab into a handheld unit called a luminometer. Results are available within seconds. Good products will come with a free software that will permit to identify problematic areas, monitor trends and store results. It is a very tool to add to an audit system.

Fast, reliable and quality results

It is important to understand that ATP testing is not a microorganism detection method. ATP testing, is a cleaning verification test. It won’t tell you what’s on the surface, but it will tell you that there is something on the surface. A lot of healthcare professionals see the value that ATP monitoring offers. It empowers auditors, infection prevention staff and environmental services specialist to verify if cleaning was done properly in seconds. The speed at which the results are obtained is very appreciated in healthcare settings. If a result is out of specification, then corrective action can be taken immediately. Infection control staff often witness a direct correlation between low ATP levels and lower healthcare associated infection rates. Remember that environmental contamination is directly linked to up to 40% of healthcare associated infections.

It’s been a year and a half since we started www.ali-flex.com. From the beginning, the blog purpose was mainly to ramble about disinfection. Hence, the name of this new web site!

We know from many comments that you liked our old posts, so we brought them to this new website.

Before I forget, www.ali-flex.com is more alive than ever, but will from now on be dedicated to the Ali-Flex, Chlorinated Disinfectant Cleaner. One of the main advantages of Ali-Flex RTU is to be a disinfectant as well as a cleaning product. Ali-Flex RTU is ready to use and does not require any dilution, which allows avoiding wrong manipulations or dilution while saving time. Ali-Flex uses exclusive Certiklör Technology.

The difference with our Certiklör stabilized hypochlorite?

The name says it all: stabilized hypochlorite!

Our multidisciplinary team of skilled scientists took 2 years to stabilize the hypochlorite solution. What is the secret? I’m afraid that’s like a little like the Caramilk’s secret! All I can say is that the ingredients that uses this technology have been carefully selected and expertly designed to give hypochlorite increased stability.
And who says stabilized hypochlorite, says better disinfection, less smell and increased cleaning!

If you wish to ramble about it, do not hesitate to share this website with your collegues.

Everything started back in the 40s. A research team in Uganda, lead by Alexander Haddow, was studying the yellow fever virus near Entebbe. In April 1950, the team isolates a new virus from a monkey used as a test animal in the Ziika forest.

The first human clinical case was described in 1954 in Nigeria. Then, in 1956, an experiment was conducted on a volunteer who got infected with the Zika virus through bites of infected mosquitoes. The subject developed a weak fever with a mild skin rash. The symptoms disappeared within a week. No more doubt, the Zika virus can infect human being via a mosquito bite.

The Zika virus was isolated in numerous species of Aedes mosquitoes in Africa and Malaysia. In 2007, the virus was identified in Micronesia, in what was the first large scale epidemic. Since then, the Zika virus has been considered as an emerging virus.

Aedes aegypti Mosquitoes

During 2013, an outbreak was raging in French Polynesia. The virus rapidly spread and was confirmed in the five archipelagos of French Polynesia which count roughly 270,000 inhabitants. Between October 2013 and March 2014, the number of infected persons is estimated at 28,000 individuals. 73 cases of Guillain-Barré syndrome were described during this epidemic. The Guillain-Barré syndrome is a rare affection that can cause muscle weakness and even paralysis. Sporadic cases of Zika virus disease were described throughout Oceania.

In Brazil, at the start of 2015, an increasing number of patients presenting symptoms similar to the Dengue virus disease were observed. This increase stroke the attention of Brazilian Public Health authorities. An infectious disease specialist evaluated some patients and laboratory results confirmed that the virus was not the Dengue nor the Chikunguya virus. In March 2015, the Zika virus was confirmed by the Carlos Chagas Institute. It was the first time that Zika virus disease was contracted in the Americas.

The virus strain isolated in Brazil is somewhat close to the Asian strains with similarities to the virus isolated in Oceania a few years ago. Some experts believe that the virus was imported into Brazil during the World Championship of pirogue (va’a) that was held in Brazil in August 2014. Four Oceanian countries where the virus is circulating were present at the Championship. To this day, it was estimated that about 1.5 million cases of Zika virus disease occurred in Brazil, which makes it the biggest Zika virus outbreak ever recorded. It is now spreading to other countries where the Aedes mosquitoes are present. The Zika virus is suspected to be linked to microcephaly touching the fœtus of infected mothers. According to the Brazil Health Minister, 4,783 suspects cases of microcephaly were described so far (February 2016). Active research is ongoing to find if and how can the Zika virus be related to birth defects.

Zika virus is an arbovirus transmitted by Aedes mosquitoes. It was discovered in 1947 in a monkey in Uganda. Zika virus is mainly present in Central America and South America but also in Africa and Oceania.

Zika virus, what is it?

With the Zika virus, it is reporteded that nearly 3 out of 4 infections do not present any symptoms. When symptoms occur, it looks like the flu: fever, headache, body aches with rashes, beginning 3-12 days after being bitten by mosquitoes. Zika virus can also manifest as conjunctivitis or pain behind the eyes, as well as swelling of the hands or feet. The disease is not directly fatal.

Why are pregnant women particularly at risk?

If a pregnant woman is infected, she can pass the virus to her baby through the placenta or during birth.

It is suspected that pregnant women infected with the virus could give birth to babies with microcephaly. Babies are born with a head circumference below 33 cm and irreversible mental retardation.

However, there is no fully proven causal link between Zika and microcephaly and because some mothers do not believe they had the virus.

What precautions should you take?

There is no vaccine against the Zika virus. It is recommended to protect yourself against bites by wearing long clothing and using insect repellent and mosquito nets.
According to the official website of the Government of Canada (canadaensante.gc.ca)

No local transmission of Zika virus have been reported in Canada. At present, the mosquitoes that transmit Zika virus are not found in Canada because of the climate. So the likelihood of transmission is very low in the country.

Lassa fever could become a topic of much more serious concern

Low potential for contamination of surfaces

Zika virus is mainly transmitted through mosquito bites. However, hygiene and safety should follow their normal procedures including disinfection of high potential contamination of surfaces and hand washing.

Press release of the MSSS

On 29 January 2016, the national public health director, Dr. Horacio Arruda, also issued a statement to inform the public about Zika. You can read the detail here

How to obtain a more effective disinfection with Certiklör?

What is Certiklör? The name of a new chemical? A new government certification?

None of the above! Simply put, Certiklör technology is the insurance for you, your patients and all Canadians to achieve a better, more efficient and high quality disinfection. Certiklör is a proprietary technology developed by Lalema for you. This technology ensures that you have in the bottle, an effective stabilized hypochlorite, and here to stay!

Stabilized hypochlorite?

Yes, yes! Let me explain. The hypochlorite that is found in bleach for example, flies away usually at a fast rate of more than 1% per month. This means that after 12 months, there will remain only small amounts of the active ingredient: the hypochlorite found in bleach! Imagine how fast this bleach goes away when it’s on the surface to be disinfected in the open air when it does so quickly when, in a closed container!

The difference with our Certiklör stabilized hypochlorite?

The name says it all: stabilized hypochlorite!

Our multidisciplinary team of skilled scientists took 2 years to stabilize the hypochlorite solution. What is the secret? I’m afraid that’s like a little like the Caramilk’s secret! All I can say is that the ingredients that uses this technology have been carefully selected and expertly designed to give hypochlorite increased stability.
And who says stabilized hypochlorite, says better disinfection, less smell and increased cleaning!

How to know if a product uses Certiklör stabilized hypochloritetechnology?

Now, how can you determine which Lalema products use this technology ? Easy! Look at the product label! For now, look at Ali-Flex RTU and Ali-Flex LF.
So if you care about your health, life quality and efficiency at work, think Certiklör stabilized hypochlorite!

October 15th is a day dedicated to increasing awareness and understanding about the importance of handwashing.

Handwashing is easy

Only a small amount of water and soap are necessary to accomplish a small action that provides great benefits. It takes 30 seconds and a bit of hand rubbing.

Handwashing works

Washing hands after using the toilet and before handling food can dramatically reduce the risk of infections such as foodborne infection. This year, handwashing was critical in the prevention of the Ebola virus in West Africa.

Handwashing is for everyone

We always ask children to wash their hands before eating, when they are back from school or after playing in the yard. From toddlers to elderly, handwashing never loses its importance. Infections can be transmitted by anyone to everyone. In order to protect children or elderly, everyone should wash their hands. After all, it is the most cost-effective public health intervention.

Working long hours in an upright position rings a bell to you? Back pain, stress and fatigue are your daily meals? There may be a solution for you.

First: Reduce fatigue with an anti-fatigue mat

One of the features found in this type of carpet is the presence of an absorbent foam. Has it been developed by NASA? In fact, we only need to know if it works. If fatigue is reduced and comfort is improved, then risk of injury and error is reduced.

Second: a unique environment

Anti-fatigue mats are found in dry, wet or oily environement. It is however possible to have a dry environment where there is a risk of contamination.

Most ergonomic mats designed for a dry environment have no backing as shown by the following picture:

When the mat is placed in an environment where there is a risk of contamination, for example in a intensive care unit, a nurse workstation or an examination room, this can be a real problem. Indeed, how can one ensure the disinfection of such a foam pad, an absorbent material, is located under the carpet ?

The dilution of chemical products in housekeeping is certainly one of the aspects where the lack of knowledge is most evident.

Dilution is often misunderstood

Effectively, there are unfortunately too many housekeepers that have the habit of adding a too large quantity of chemicals to their washing solution. Therefore, if they would come to a stop for an instant, in order to realize up to which point this may be harmful to their work, this bad habit would be lost very quickly.

We must indeed remember that cleaning chemical products are conceived to reach their maximum potential with a very precise volume of water.

Consequently, we must use a dilution measuring system that should be standardized for the whole working team.

Effects of under-dilution

With respect to Health and Safety, under dilution can cause:

Dermatitis problems

Respiratory tract problems

Toxic fumes may cause cancer, difficult to prove and difficult to be recognized by the CSST.

With respect to work efficiency and surfaces, under dilution can:

Damage surfaces, since an under-diluted alkaline product will make a dull effect, by opening the pores of the floor coverings and thus allowing the deposit of alkalis. Acids, on the contrary, close the pores of the floor coverings and also burn the surface.

Leave a film on the surface that will give a continuous streaky appearance and this film being greasy will facilitate the adherence of dirt.

Cause enormous rinse problems because it will create foam in the solution container, which anyway has no cleaning effect.

Disturb disinfection efficiency.

Result in a loss of efficiency, since a well-diluted product reduces the physical demand to perform a task and favors the mechanical action.

Effects of over-dilution

Over dilution can cause:

Result in no disinfection.

Result in loss of efficiency since an over-diluted product will increase the physical workload at the expense of the mechanical action.

The Next Big Thing in Disinfection: Biofilm

Have you ever wondered what are the main factors affecting the efficacy of disinfection and sterilization in the healthcare facility? U.S. Centers for Disease Control and Prevention lists seven major causes of microbiological persistence on surfaces:

Number of microorganisms

Microbial resistance to biocides

Concentration and Potency of Disinfectants

Duration of Exposure

Chemical and Physical Factors

Presence of Organic or Inorganic Matter

Biofilms

For many experienced healthcare professionals, these factors are well known and often well dealt with. However, did you know the difference between soil (organic and inorganic matter) and biofilm? They both can significantly lower the efficacy of disinfection, but the biofilm is much harder to remove and control.

What is biofilm and how does it form?

Biofilm is an aggregation of microbial cells, surrounded by a protective layer of extracellular polymeric matrix, which attaches itself to any surface found in the hospital environment and becomes a source of contamination. Formation of complex, multicellular communities by microorganisms is a natural phenomenon which helps bacteria or fungi to survive environmental stress such as cleaning and disinfection.

Many pathogens require a presence of conditioning layer made from organic soil to settle and start extracellular matrix synthesis. But there are bacteria which don’t really need much help to start a biofilm community. When pathogens settle down and surround themselves in an extracellular polymeric substance (EPS), they are much harder to kill.

It has been reported that bacteria found in biofilm can be up to 1,000 times more resistant to biocides than their planktonic counterparts.

How to outsmart and fight biofilm?

Despite biofilms’ rigid structure and resistance mechanisms, biofilm cells can still be outsmarted. Since EPS is the ultimate protective barrier and communication route for pathogens, the control of biofilm should start with disruption of the EPS itself, followed by an application of a biocide.

MERS-CoV: Practical Tips for Disinfection

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is slowly spreading through the Middle East and Asia. Transmission, so far, seems to happen when a close contact with an infected individual occurs. This type of transmission has led to many healthcare associated infections to this day. As an example, a patient that waited for 2.5 days in a Seoul emergency department, end up transmitting the disease to 55 persons.

So far, the case-fatality rate is around 36 %, which is very high. However, this number may not be representative of a normal population and its kill rate is likely to be overestimated. A bias might exist when looking at the population who acquired the virus in Korea. Of the 171 cases, many had underlying medical conditions and have a median age of 55.

Official recommendations

CDC and Health Canada issued a few recommendations on infection control and prevention so far, and more is likely to be available soon. Regardless of their recommendations few data are available on environmental hygiene and disinfection practice regarding MERS-CoV in healthcare settings. Also, the transmission through the environment is not well known for this virus.

How to disinfect?

Regarding disinfection few information are available. Coronaviruses are non-enveloped virus which makes them more resistant to certain disinfectant. As an example, it is known that a 400 ppm solution of quaternary ammonium compounds is ineffective against those viruses. Sodium hypochlorite at a minimum of 1,000 ppm seems to be sufficient, however a higher concentration would be optimal in healthcare settings. Very few data exist regarding other disinfectant technology.

At this moment, isolation with contact-droplets precaution is advised. In spite of the fact that it was suggested during the SARS outbreak that this type isolation might not be sufficient. Even though these two viruses are similar, we must remember that many differences exist. Thus we must be careful with extrapolation of data.

It was a pleasure to chat with some of you about current practice in environmental hygiene regarding infection control.

We hope you liked Ali-Flex RTU, our low odor, non-corrosive, broad spectrum and ready to use disinfectant cleaner. There is a great potential for improvement in the field of environmental hygiene and we are dedicated to it.

We look forward to hearing from you, but in the meantime, with best regards we remain.

The Ali-Flex Team (Manon, John and Remi)

PS If you want to know more about Ali-Flex RTU, visit our main web site.

Infection prevention and control Canada will hold its annual conference in just a month. This year it will take place in beautiful Victoria, BC. The theme surfing waves of change promise to bring a wind of new approaches and effective solutions to enhance the practice of ICPs. Key opinion leaders and other highly influential speakers will provide a tsunami of information through presentation and multiple discussions. With a special focus on compliance reporting on environmental hygiene and hand hygiene, this conference might inspire a real wave of change.

IPAC Canada 2015

IPAC is also an excellent opportunity to meet with the industry leader in the broad field of infection prevention. Whether you are looking for new environmental hygiene tools, a better software to monitor your antimicrobial stewardship program or hand hygiene audit solutions, key industries will be there. It will also be the perfect occasion to get familiar with the Ali-Flex brand.

Will you be on board to meet the rip tides of change ? We will! Meet us at booth 72!

We are very proud to invite you to our 3rd edition of EXPO LALEMA. Last year was a frank success at that was because so many of you, dear clients, collaborators and friends showed up. Beware, we expect this year to be even better!

Ali-Flex product lines will be displayed

The whole Ali-Flex product line will be displayed and you will be meeting with our environmental hygiene specialist. Furthermore, exclusive announcements will be made.

Dedicated Partners

We are lucky to have such dedicated partners and always there for our clients and ourself. This year some of our most respected partners will join us. Rubbermaid, 3M, Kimberly Clark, Cascades, Bobrick, Comac, Eco II, Nacecare et Atlas Graham will be there to answer your questions and presenting you the way they rethink hygiene.

Expo Lalema : Its a rendezvous

This year we will be receiving you in the Canada pavilon on the Notre-Dame island. Many surprises await you!

Don’t forget to save the date, you won’t regret it!

We will be waiting for you on April 30th 2015. Doors will open at 11h00 at 1, Circuit Gilles Villeneuve, Pavillon du Canada Toundra room.

You can subscribe via e-mail (mlandry@lalema.com) or directly on our website site at : www.lalema.com.

In the actual market, you can find many cleaner-disinfectants. When it comes to consumer products, you’ll find a lot of brand, most of them are ready to use. It means you do not have to dilute the product and use it as is to disinfect. For industrial and institutionnal use, most of cleaner-disinfectants are concentrated if not ultra-concentrated. In that case, why choose a ready-to-use Bleach based Cleaner-Disinfectant for institutionnal use?

Main benefit of a low-foam concentrated product

Let’s talk about a product like Ali-Flex LF, a product like this one offers a high concentration for general disinfection in hospitals. On a day to day basis, with the right dilution system, the surfactants contained in ALI-FLEX LF increase the wetting power of this chlorinated disinfectant and contribute to degrease and remove dirt from hard non porous surfaces such as countertops, walls, floors, toilets, commode chairs, etc.

Main benefit of a ready-to-use chlorinated disinfectant cleaner

When it comes to infection control, one important aspect is to reduce the risk. We know that dilution systems can sometimes be flawed and not consistant with delivery concentration. Therefore, it is crucial to obtain a consistant known concentration. That is exactly what Ali-Flex RTU can provide: a factory consistant concentration of 6000 PPM (when packaged) with a validated shelf-life.

Of course it may generate more plastic in the environnement. Recycling may then be on option to consider. At the same time, when patient’s lifes are at risk, all factors that can reduce the risk is of important value.

What are you using in your facility?

Tell us what kind of product you are using. Are you in control? Are you facing problems when it comes to stop eclosion? Surely we can help you! Let’s talk!

First In, First Out (FIFO): also applies to disinfectant!

Some of you may be familiar with the FIFO concept. FIFO is a method for organizing and manipulating goods such as food, it is also used in computer science to organize data. In the food industry, FIFO is essential in order to ensure freshness, preventing foodborne illness and controlling costs.

Can a cleaning product expire?

When it comes to disinfectant the same goes, a fresher or let’s say a newer product is better. I sometimes hear people saying that soap doesn’t expire. Even though the shelf life of soap is way greater than most food items, soaps and other cleaning products do expire. Same goes for disinfectant the active ingredient of a disinfectant whether it is quats, chlorine or peroxide will diminish over time. Hence to ensure a proper disinfection it is important to use product that are not expired. A good way to achieve this is by implementing a FIFO rotation system. By always using the oldest disinfectant that you have in inventory first, you make sure that you won’t get stuck with old and maybe expired stuff!

How to know if a cleaning product is expired?

This is a broad question… For disinfectant it is pretty easy, Health Canada and the EPA requires that all disinfectant have an expiration date on their label. Most cleaning product however does not have an expiration date and the shelf life varies greatly among them. But some signs won’t get you wrong. If the color, the odor, the consistency of the product is changed or if you see a deposit in the product it might be a good sign that the product is expired. In case of doubt, call the manufacturer, with the lot number every good manufacturer will be able to tell you if the product is expired.